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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rilmenidine (RIL) is a novel antihypertensive drug selectively acting at the sites of imidazoline receptors. Compared with diuretics, beta-blockers, Ca2+ antagonists and angiotensin converting enzyme inhibitors, the four major groups recommended by the US Joint National Committee as first-line antihypertensive drugs, RIL appears to meet the same criteria of efficacy, safety, and acceptability. Rilmenidine dose-dependently decreases blood pressure (BP), acting as a vasodilator by decreasing vascular resistance through inhibition of the adrenergic nervous system, even while the BP changes due to standing and exercise. In comparison with placebo, RIL significantly decreased BP. In double-blind comparative trials versus first-line diuretics and beta-blockers, RIL normalized BP in approximately 60% patients, showing a similar efficacy to other drugs. In contrast with hydrochlorothiazide, RIL decreased total cholesterol and did not change plasma potassium levels. No tachyphylaxis was observed during long-term treatment. Central side effects, which have contributed to the limitation of the use of alpha 2-agonists as second- or third-line therapy for hypertension, were significantly less frequent with RIL than with clonidine or methyldopa. Indeed, the incidence of dry mouth and drowsiness during double-blind comparative trials versus clonidine and methyldopa was significantly lower with RIL. This absence of central side-effects was confirmed in double-blind comparative trials versus hydrochlorothiazide and atenolol. In contrast with clonidine, no sodium retention or weight gain were observed during chronic treatment with RIL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Rilmenidine: a novel approach to first-line treatment of hypertension. 135 Jul 33

Left ventricular hypertrophy is an adaptation of the cardiac fibre to the imposed mechanical overload. This adaptation is quantitative; increased numbers of contractile units with decreased wall stress. Qualitative changes in genomic expression allow the hypertrophied cardiac fibre to develop a normal active tension at the expense of its maximal shortening velocity. These changes are preceded by the temporary expression of proto-oncogenes, of genes of the proteins of thermal shock and by reorganisation of the cytoskeleton, all possible candidates of the regulation of the gene expression in cardiac hypertrophy. In the long-term, the hypertrophy becomes harmful: inadequate subendocardial vascular development; the lowering of the Vmax is beneficial at cellular level but eventually affects cardiac output; ventricular compliance decreases with the development of fibrosis; changes in calcium metabolism are arrhythmogenic. Modifying, prolonging and improving the natural process of adaptation is clearly the first therapeutic objective in order to decrease the hypertension and cause the hypertrophy to regress. Propranolol acts by reducing the cardiac work load. However, betablockers have the disadvantage of increasing the relative density of the subendocardial collagen. Rilmenidine decreases the quantity and density of the collagen. Vasodilators and diuretics induce regression of the myocytic hypertrophy by lowering the threshold of adaptation of these cells, but they have no effect on collagen synthesis. Angiotensin converting enzyme inhibitors which have been shown to be beneficial in controlling hypertension, induce a decrease in the hypertrophy of the myocytes and reduce fibrosis.
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PMID:[Remission of left ventricular hypertrophy of hypertensive origin. Experimental data]. 215 Apr 72

The efficacy and acceptability of Rilmenidine (RIL) were assessed in a multicentre, controlled, double-blind trial versus hydrochlorothiazide (HCZ) in patients with mild to moderate hypertension. After an initial 4 week washout period on placebo, patients with diastolic BP of between 90 and 110 mmHg were administered in monotherapy either RIL 1 mg or HCZ 25 mg for four weeks (Day 0-Day 28). In the following four weeks (Day 28-Day 56), those with diastolic BP of over 90 mmHg were given, in association, the antihypertensive agent that they had not received initially. The other patients continued the trial with single daily doses of monotherapy. Two hundred and fourty four patients (48.4 +/- 0.6 years) with supine systolic and diastolic BP of 155.86 +/- 0.96 mmHg and 101.02 +/- 0.28 mmHg respectively were randomly allocated to two comparable treatment groups (RIL, n = 120 and HCZ, n = 124). The systolic and diastolic BP decreased significantly between Day 0 and Day 28, as much at Day 14 as at Day 28 in both treatment groups. The antihypertensive effect was comparable: at Day 28 the mean fall in systolic/diastolic BP was 16/10 mmHg in the RIL group and 15/9 mmHg in the HCZ group (NS). The clinical acceptability was equivalent in the two groups: secondary effects were responsible for one patient's withdrawal in each group and their incidence was 5% on average, 10% for the most common.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Multicenter, double-blind study comparing rilmenidine 1 mg and hydrochlorothiazide 25 mg in 244 patients]. 251 8

Rilmenidine (RIL) is a new antihypertensive agent which lowers sympathetic tone, so reducing systemic peripheral resistance. The effects of a single dose of RIL (1 mg) on arterial function were the object of a preliminary randomised double-blind versus placebo trial in 14 patients with hypertension after a one month washout period on placebo. The following parameters were recorded before (T0) and 4 hours after administration (T4): blood pressure, heart rate (automatic recordings), diameter of the humeral artery (D), mean blood flow velocity (Vm) by an 8 MHz duplex pulsed Doppler system, local forearm resistances (LR = mean BP/D2 Vm/4), carotid-femoral pulse wave velocity (PWV) and humeral arterial wall tension (mean BP.D/2). The two groups were compared by statistical analysis of variance with two crossed factors. RIL significantly lowered systolic BP (p less than 0.02), diastolic BP (p less than 0.05) and mean BP (p less than 0.01) without changing the heart rate. The D and PWV were unchanged in the RIL group. There was a significant improvement in arterial wall tension (-6.7% vs + 1.1%; p = 0.02) associated with a tendency to increase the PWV (45% vs 4%; p = 0.097) and to decrease LR (46% vs 10%; p = 0.062) although those changes were not statistically significant compared with those observed with placebo. These initial results indicate that the hypotensive effect of RIL is accompanied by a reduction in humeral arterial wall tension which occurs without any change in arterial diameter. This also reflects a change in the pressure-volume relationship with RIL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effects of rilmenidine on arterial parameters in essential arterial hypertension]. 251 9

The hypertensive heart is an example of myocardial adaptation to a chronic mechanical overload. In this model, the myocardium adapts by quantitative mechanisms such as hypertrophy and by qualitative processes at sarcomere and cell membrane level. Cardiac failure occurs when these mechanisms become inadequate although other phenomena such as collagen, coronary resistances, adverse hormonal effects and associated pathologies also play a role. This report describes an experimental model: uninephrectomised rats were made hypertensive by administering a DOCA-salt diet. The resulting cardiac hypertrophy was reduced and the hypertension corrected by propranolol. Rilmenidine, a new antihypertensive agent, has no effect on cardiac hypertrophy but it does reduce myocardial collagen concentrations significantly which has potentially important beneficial consequences.
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PMID:[The heart in patients with hypertension: effects of rilmenidine on experimental cardiac hypertrophy of hypertensive origin in rats]. 253 68

The antihypertensive properties of rilmenidine, an oxazoline derivative, have been demonstrated in several experimental models of hypertension after short- or long-term administration. In pentobarbitone-anesthetized spontaneously hypertensive rats, intravenous rilmenidine (0.1 to 1 mg/kg) dose-dependently reduced blood pressure and heart rate. Upon long-term subcutaneous infusion (5 to 15 mg/kg per day) in conscious spontaneously hypertensive rats, rilmenidine induced a dose-dependent decrease in both cardiovascular parameters. In conscious sino-aortic denervated dogs, rilmenidine (1 mg/kg orally for two weeks) significantly reduced blood pressure and heart rate. The hypotensive action of rilmenidine is mediated through a reduction in peripheral sympathetic tone, resulting from a central action and possibly a peripheral action. Rilmenidine also decreases catecholamine release from the adrenal medulla which might contribute to the antihypertensive effect. Therefore, rilmenidine acts similarly to clonidine and related compounds in order to lower blood pressure, i.e., reduction of sympathetic tone. Nevertheless, although it binds to alpha 2-adrenoceptors, rilmenidine did not cause sedation in animal models: at doses up to 10 mg/kg in mice and rats, it did not prolong the barbiturate-induced sleeping time and did not modify the spontaneous locomotor activity in rats at doses up to 2.5 mg/kg. These results demonstrate a dissociation between sedative and antihypertensive effects of rilmenidine. Three hypotheses have been proposed to explain why this drug is almost devoid of sedative activity in animal experimental models: (1) unknown properties counteracting the alpha 2-adrenoceptor-mediated sedation; (2) a preferential action at the peripheral level; (3) central receptors involved in sedation and hypotension may be different. The intimate mechanism underlying the hypotensive effects of rilmenidine is currently under investigation. The evidence for rilmenidine binding on central sites named "imidazoline sites" involved in blood pressure regulation could possibly provide further insight into its mechanism of action and explain the duality of its effects.
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PMID:Recent advances in the pharmacology of rilmenidine. 257 Dec 91

Rilmenidine is a novel antihypertensive agent related to alpha 2-adrenoceptor agonist, used in the treatment of mild or moderate hypertension at the oral dose of 1 mg once a day or 1 mg twice a day. The pharmacokinetic parameters were investigated after single or repeated administration in healthy subjects, using labeled and unlabeled compounds. Rilmenidine was rapidly and extensively absorbed, with an absolute bioavailability close to one and a time to peak plasma concentration of two hours. Rilmenidine was not subjected to presystemic metabolism. Distribution was independent of the free fraction since rilmenidine was weakly bound to plasma proteins (less than 10 percent). The volume of distribution was approximately 5 liters/kg (315 liters). Elimination was rapid, with a total body plasma clearance of approximately 450 ml/minute and an elimination half-life of approximately eight hours. Renal excretion was the major elimination process (two thirds of the total clearance); the parent drug in urine accounted for about 65 percent of the dose administered. Metabolism was very poor; few metabolites were found in urine and no metabolites were detected in plasma. Linear pharmacokinetics was demonstrated for rilmenidine from 0.5 to 2 mg; at 3 mg, a slight deviation from linearity was observed. In repeated administration, the linearity with dose of the pharmacokinetics of rilmenidine was confirmed.
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PMID:Pharmacokinetics of rilmenidine. 278 23

In 30 patients with mild hypertension (diastolic blood pressure, 95 to 105 mmHg), the antihypertensive effect of rilmenidine 1 mg was compared in a double-blind study, with the effect of hydrochlorothiazide 25 mg. Patients not satisfactorily controlled received a combined therapy on the same doses of the two drugs used. Rilmenidine and hydrochlorothiazide induced a significant reduction (p = 0.01) of supine and erect systolic/diastolic blood pressure 23 hours after drug intake with no change in heart rate. This effect was due to a reduction in cardiac output (bioimpedance method) significant (p = 0.05) only for rilmenidine. Both drugs controlled the increase of effort systolic blood pressure in comparison with placebo on systemic vascular resistance treadmill exercise testing. Effort cardiac output was increased by each treatment in comparison with baseline values. Both at rest and on exertion, there was no effect on systemic vascular resistance induced by the two drugs. In a second group of 10 patients with moderate hypertension (diastolic blood pressure, 105 to 115 mmHg), rilmenidine 1 mg was administered in order to evaluate its efficacy and hemodynamic effects (bioimpedance and radionuclide ventriculography), at rest and during a lying cycloergometer effort test. The drug induced a significant decrease in blood pressure at rest and on exertion four hours after drug intake. This effect was due to a reduction (p = 0.05) in systemic vascular resistance, whereas cardiac output and heart rate remained unchanged. Our results show that the reduction in systolic/diastolic blood pressure induced by rilmenidine 1 mg is comparable with that induced by the well-known antihypertensive drug hydrochlorothiazide in mild hypertension. In moderate hypertension, the 1-mg dose appears to be insufficient in controlling the blood pressure in all patients. The drug exerts its antihypertensive effect through the normalization of the altered hemodynamic parameters of hypertension (high cardiac output and/or increased systemic vascular resistance). Rilmenidine also respects the physiologic increase in blood pressure and cardiac output on exertion.
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PMID:Effort blood pressure control in the course of antihypertensive treatment. 278 27

Rilmenidine is a novel alpha 2-adrenoceptor agonist, used in the treatment of mild or moderate hypertension at the oral dose of 1 mg once or twice daily. The pharmacokinetic parameters were investigated after single or repeated administration in healthy subjects, using labeled and unlabeled compounds. Rilmenidine was rapidly and extensively absorbed, with an absolute bioavailability factor close to 1 and a maximal plasma concentration achieved within 2 hours. Rilmenidine was not subject to presystemic metabolism. Distribution was independent of the free fraction because rilmenidine was weakly bound to plasma proteins (less than 10%). The volume of distribution was approximately 5 l.kg-1 (315 liters). Elimination was rapid with a total body plasma clearance of approximately 450 ml.min-1 and an elimination half-life of approximately 8 hours. Renal excretion was the major elimination process (two-thirds of the total clearance). Metabolism was very poor, with a renal elimination of rilmenidine as the parent drug (urinary fraction of rilmenidine was about 65% and no metabolite plasma levels were detected). Linear pharmacokinetics were demonstrated for rilmenidine from 0.5 to 2 mg but, at 3 mg, a slight deviation from linearity was observed. In repeated administration, the linear disposition of rilmenidine with dose was confirmed.
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PMID:Pharmacokinetics of rilmenidine in healthy subjects. 289 58

Rilmenidine, an alpha 2-adrenoceptor agonist, was studied (1 mg single dose) in order to determine the effects of pathology on its basic pharmacokinetic parameters. Because of the mainly renal elimination of rilmenidine, studies involved hypertensive, elderly hypertensive, renal insufficient and hepatic insufficient patients. Hypertension was found to influence neither the absorption, the distribution nor the elimination processes; the linearity in the range of 1 to 2 mg and the absence of accumulation in long-term treatment were confirmed. In contrast, in the elderly, the absorption phase was delayed. The slight decrease in the apparent volume of distribution (-12%), with a notable decrease in the apparent total clearance (-50%) led to a prolonged elimination half-life (+50%). In renal failure, linear relations between the degree of renal impairment and the elimination parameters were shown. These relations allow the evaluation of the predicted steady-state level of rilmenidine for a given degree of renal failure. In hepatic insufficiency, the modification of rilmenidine disposition concerned exclusively the elimination phase in which apparent clearance was decreased approximately 20%. In conclusion, these results lead to a decreased dosage regimen in patients with severe renal failure.
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PMID:Pharmacokinetics of rilmenidine. 289 59


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